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General NPI Number Information
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NPI Number | 1881743128
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Entity Type | Organization
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Legal Business Name | GWENDELLYN L MCLEAN MD PA
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Dates
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Enumeration Date | 01/09/2007
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Last Update Date | 03/07/2008
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Provider Practice Location Address
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Address Line | 2022 BROOKWOOD MEDICAL CENTER DRIVE SUITE 409 ACC
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City | BIRMINGHAM
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State | AL
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Zip | 35209
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Country | US
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Telephone | 205-879-9290
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Fax | 205-879-5456
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Provider Business Mailing Address
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Address Line | 2022 BROOKWOOD MEDICAL CENTER DRIVE SUITE 409 ACC
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City | BIRMINGHAM
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State | AL
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Zip | 35209
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Country | US
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Telephone | 205-879-9290
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Fax | 205-879-5456
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GWENDELLYN LEWELLYN MCLEAN
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Credential | MD
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Telephone | 205-879-9290
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 00004159
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License Number State | AL
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